Provider Demographics
NPI:1952524282
Name:MCCLENDON, JANICE W (RDH)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:W
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:W
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1935 HILDRED
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136
Mailing Address - Country:US
Mailing Address - Phone:314-814-8514
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:MURPHY PARK O'FALLON
Practice Address - Street 2:1717 BIDDLE
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106
Practice Address - Country:US
Practice Address - Phone:314-814-8581
Practice Address - Fax:314-814-1056
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000973124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist